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CARDIAC SURGERY _____________________________________________________
A Broken Heart Corstiaan A. den Uil, M.D., Ph.D.,*,y Sakir Akin, M.D.,*,y Charles Kik, M.D.,*,y and Olivier C. Manintveld, M.D., Ph.D.*,y *Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; and yDepartment of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands doi: 10.1111/jocs.12381 (J Card Surg 2014;29:794) A 70-year-old male presented with an inferior wall ST segment elevation myocardial infarction and, following a primary percutaneous coronary intervention on the right coronary, was found to have an inferior ventricular
septal defect (VSD) on transthoracic echocardiography (TTE) (Fig. 1A). This was repaired emergently using autologous pericardium. He subsequently developed congestive heart failure and a dehiscence of the patch in
Figure 1. (A) TTE image, modified apical four-chamber view, complete inferior postinfarction ventricular septal rupture (arrow). (B) 3D transesophageal echocardiography, 1058 transgastric view, dehiscence of the pericardial patch (asterisk) in the region of the posterior medial papillary muscle. (C) Cardiac MRI, without contrast, patch dehiscence (arrow), creating an additional ‘‘space’’ filled with blood shunting from left to right ventricle. (D) In vivo remaining defect during re-repair surgery (arrow). Conflict of interest: The authors acknowledge no conflict of interest in the submission. Address for correspondence: Corstiaan A. den Uil, M.D., Ph.D., Department of Cardiology, Thoraxcenter, Erasmus Medical Center, ‘sGravendijkwal 230, NL-3015 CE Rotterdam, The Netherlands. Fax: þ31 10 7035269; e-mail:
[email protected]
the region of the posterior medial papillary muscle, which was confirmed by 3-D transesophageal echocardiography (Fig. 1B), and magnetic resonance imaging (MRI), (Fig. 1C). He subsequently underwent re-repair using a Gortex patch (Fig. 1D) and was ultimately discharged home in NYHA Class I.
